Diabetic retinopathy is the major cause of vision loss in middle-aged adults. Alteration of the blood-retinal barrier (BRB) is the hallmark of diabetic retinopathy and, subsequently, hypoxia may result in retinal neovascularization. Tight control of systemic factors such as blood glucose, blood pressure and blood lipids is essential in the management of this disease. Vascular endothelial growth factor (VEGF) is one of the most important factors responsible for alteration of the BRB. The introduction of anti-VEGF agents has revolutionized the therapeutic strategies used in people with diabetic retinopathy, and the use of laser therapy has been modified. In the present article, we examine the clinical features and pathophysiology of diabetic retinopathy and review the current status of new treatment recommendations for this disease, and also explore some possible future therapies. Keywords: blood-retinal barrier, diabetes complications, diabetes mellitus, diabetic retinopathy, vascular endothelial growth factor [2,3]. Although laser photocoagulation therapy has been the mainstay of management therapy in addition to control of systemic factors, the use of intravitreal anti-vascular endothelial growth factor (VEGF) agents and steroids in recent years has revolutionized the management of diabetic macular oedema. In the present review, we will discuss the pathogenesis of diabetic retinopathy and the treatment strategies currently available for the treatment of diabetic macular oedema and proliferative diabetic retinopathy (PDR; Table 1). Clinical FeaturesThe earliest clinical lesions of diabetic retinopathy are microaneurysms, or focal dilations of retinal microvessels seen as deep red dots, mainly in the posterior pole. Usually these lesions appear and disappear over time and cause no symptoms themselves. Microaneurysms are present in almost all people with type 1 diabetes of 20 years duration, and in 80% of people with type 2 diabetes [4,5]. Based on the absence or presence of new vessels, diabetic retinopathy is classified

ObjectiveTo assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy.MethodsIn a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013.ResultsThe absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0 % in the control and intervention groups, respectively (p < 0.001). The absolute increases in SBA delivery rates from the pre-intervention period to the intervention period before the implementation of the free maternity care policy were 4.7 and 17.2 % in the control and intervention groups, respectively (p < 0.001). After the policy implementation the absolute increases from pre-intervention to post-intervention were 1.8 and 11.6 % in the control and intervention groups, respectively (p < 0.001).ConclusionThe percentage of SBA deliveries at the intervention health facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.